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Drugs, discipline and death: Causes and predictors of mortality among people who inject drugs in Tijuana, 2011-2018.
West, Brooke S; Abramovitz, Daniela A; Gonzalez-Zuniga, Patricia; Rangel, Gudelia; Werb, Dan; Cepeda, Javier; Beletsky, Leo; Strathdee, Steffanie A.
Afiliação
  • West BS; School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, United States; Division of Infectious Diseases and Global Public Health in the Department of Medicine, University of California San Diego, San Diego, CA, United States. Electronic address: bsw2110@columbia.edu.
  • Abramovitz DA; Division of Infectious Diseases and Global Public Health in the Department of Medicine, University of California San Diego, San Diego, CA, United States.
  • Gonzalez-Zuniga P; Division of Infectious Diseases and Global Public Health in the Department of Medicine, University of California San Diego, San Diego, CA, United States.
  • Rangel G; Mexico/US Border Health Commission, Tijuana, Mexico.
  • Werb D; Division of Infectious Diseases and Global Public Health in the Department of Medicine, University of California San Diego, San Diego, CA, United States.
  • Cepeda J; Division of Infectious Diseases and Global Public Health in the Department of Medicine, University of California San Diego, San Diego, CA, United States.
  • Beletsky L; Division of Infectious Diseases and Global Public Health in the Department of Medicine, University of California San Diego, San Diego, CA, United States; Northeastern University School of Law and Bouvé College of Health Sciences, Boston, MA, United States.
  • Strathdee SA; Division of Infectious Diseases and Global Public Health in the Department of Medicine, University of California San Diego, San Diego, CA, United States.
Int J Drug Policy ; 75: 102601, 2020 01.
Article em En | MEDLINE | ID: mdl-31775080
BACKGROUND: People who inject drugs (PWID) experience multiple risk factors for mortality; yet, we know little about causes of death among PWID in Tijuana, Mexico, an area with high levels of injecting and changes in policy/law enforcement responses to substance use. This study examines rates, causes, and predictors of mortality among Tijuana PWID. METHODS: Data come from a community-based cohort of PWID aged ≥18 who injected drugs in the past month. Mortality was confirmed by death certificate over 78 months during 2011-2018. Predictors of mortality were identified using time-updated Cox regression, controlling for age. RESULTS: Among 734 participants, there were 130 deaths (54 confirmed, 76 unconfirmed), with an incidence rate of 17.74 deaths per 1000 person-years for confirmed deaths (95% Confidence Interval (CI)=13.01, 22.48) and 39.52 for unconfirmed deaths (CI=32.72, 46.31). Confirmed deaths resulted from homicide/trauma (26%), overdose (26%), septic shock (18%) and HIV-related causes (9%). In multivariable analysis of confirmed deaths, baseline HIV seropositivity (adjusted Hazard Ratio [aHR]=6.77, CI=1.98, 23.17), incident HIV infection (aHR=3.19, CI=1.02, 9.96), and number of times being beaten by police in the past 6 months at baseline (aHR=1.08 per time, CI=1.04, 1.12) were predictive of death; whereas, injection cessation for 6+ months during time at risk (aHR=0.25, CI=0.33, 0.79) was protective. CONCLUSION: In addition to overdose and HIV prevention efforts, attention to structural conditions that potentiate mortality is needed, including improved access to medication-assisted treatment to support injection cessation and a shift from police as a source of harm to harm reduction.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções por HIV / Abuso de Substâncias por Via Intravenosa / Overdose de Drogas Tipo de estudo: Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: Mexico Idioma: En Revista: Int J Drug Policy Assunto da revista: SAUDE PUBLICA / TRANSTORNOS RELACIONADOS COM SUBSTANCIAS Ano de publicação: 2020 Tipo de documento: Article País de publicação: Holanda
Texto completo
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XML
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções por HIV / Abuso de Substâncias por Via Intravenosa / Overdose de Drogas Tipo de estudo: Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: Mexico Idioma: En Revista: Int J Drug Policy Assunto da revista: SAUDE PUBLICA / TRANSTORNOS RELACIONADOS COM SUBSTANCIAS Ano de publicação: 2020 Tipo de documento: Article País de publicação: Holanda